ORIGINAL ARTICLE Ponte osteotomies in thoracic deformities F. Sa ´nchez Pe ´rez-Grueso • Riccardo Cecchinato • Pedro Berjano Received: 18 September 2014 / Revised: 5 October 2014 / Accepted: 6 October 2014 / Published online: 29 October 2014 Ó Springer-Verlag Berlin Heidelberg 2014 Abstract Thoracic hyperkyphosis is a sagittal deformity that can cause back pain and neurological impairment, leading to difficulties in maintaining a straight gaze. Sag- ittal thoracic malalignment has different etiologies and different corrective strategies. An adequate preoperative planning is mandatory to address correctly the surgical treatment, using an appropriate sagittal deformities classi- fication and the rules that relate pelvic parameters to spine curvatures to determine the correction needed to restore a good sagittal alignment. Ponte osteotomies are performed in long non-angular hyperkyphotic thoracic deformities, even if idiopathic scoliosis, rigid deformities or proximal junctional kyphosis after instrumented fusions can benefit from the application of this technique that requires a mobile anterior column for the correction of the deformity. Ponte’s is, together with Smith-Petersen osteotomy, a posterior column osteotomy. The magnitude of correction can reach 10° per level if intervertebral discs are still mobile. Keywords Ponte osteotomy Á Thoracic kyphosis Á Deformity Introduction Thoracic hyperkyphosis is correlated to the development of back pain and neurological impairment [1]. The main causes of thoracic kyphotic deformity are developmental, congenital, post-infective, traumatic or iatrogenic. While vertebral malformations like hemivertebrae are congenital abnormalities that can produce a thoracic sagittal mala- lignment, Scheuermann disease is the most common deformity that occurs during the developmental age. It was first described in 1920 as a deformity due the wedge shape of thoracic vertebrae and was named ‘‘osteochondritis deformans juvenilis dorsi’’ [2]. Its incidence ranges from 1 to 8 %, being more common in boys (from 2:1 to 7:1 in respect to women). Among the post-infective hyperky- phosis, thoracic localization of tuberculosis is a frequent cause of sagittal deformity. A traumatic vertebral fracture with a wedge deformation of the body can produce a kyphotic angulation with a consequent regional deformity. Finally, a thoracic decompressive surgery without instru- mentation can lead to a late kyphotic deformity, with consequent related symptoms. Another cause of thoracic hyperkyphosis is ankylosing spondylitis (AS), an inflam- matory condition that causes an ossification of ligaments and joint capsules. In many cases, AS causes spinal deformity in cervical, thoracic and lumbar segments, with associated pain [3]. When a kyphotic deformity of the thoracic spine occurs, symptoms as local pain, neurological and gait impairment, difficulties in forward looking and deterioration in digestive and respiratory functions can appear [4]. Surgical options for the treatment of thoracic deformi- ties are determined by severity, flexibility, apex location and shape of the deformity [5]. While pedicle screw instrumentation after appropriate intraoperative positioning F. S. Pe ´rez-Grueso (&) Chief Spine Unit, Orthopaedic Department, Hospital La Paz, Madrid, Spain e-mail: perezgrueso@gmail.com R. Cecchinato 2nd Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy P. Berjano 4th Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy 123 Eur Spine J (2015) 24 (Suppl 1):S38–S41 DOI 10.1007/s00586-014-3617-z